Premorbid self‐disorders and lifetime diagnosis in the schizophrenia spectrum: a prospective high‐risk study

Abstract

Aim: The notion of a disordered self as a core disturbance of schizophrenia was proposed in many foundational texts. Recent studies, spurred by the development of the Examination of Anomalous Self-Experience (EASE), seem to indicate that selfdisorders are a specific manifestation of schizophrenia vulnerability. Follow-up studies of help-seeking, prodromal and first-admission patients have demonstrated the utility of self-disorders for predicting later schizophrenia-spectrum disturbance. We wished to extend these findings by gauging the predictive value of self-disorders in a premorbid, non-clinical population at high risk for schizophrenia. Methods:Children from the Copenhagen High-Risk Project with highgenetic risk for schizophrenia (N = 212) were assessed premorbidly (average age = 15), and diagnostically re-evaluated after 10 and 25 years. Since the EASE was not available at the time of premorbid assessment, we hypothesized that a proxy scale drawn from the Minnesota Multiphasic Personality Inventory (MMPI) could distinguish those who later developed a schizophrenia-spectrum disorder (N = 68) from those who remained healthy (N = 64). The Self-Disorder Scale comprised 32 items whose content suggested an aspect of selfdisorder as measured by the EASE.Results: Premorbid Self-Disorder Scale scores significantly predicted lifetime schizophrenia-spectrum diagnosis in the high-risk cohort. Although there was considerable item overlap between the new scale and an existing MMPI scale (psychoticism), the overlap did not account for the Self-Disorder Scale's predictive efficacy. Conclusion:The results support the notion of self-disorders as a core vulnerability feature in schizophrenia, detectable premorbidly in those developing later schizophreniaspectrum disorders.

Genetics of Schizophrenia: Overview of Methods, Findings and Limitations

“…For clinical descriptions of self-disorders in schizophrenia spectrum disorders, see Parnas and Handest (2003), Parnas et al (2005a), Henriksen and Parnas (2012), and Henriksen and Nordgaard (2016). During the last two decades, empirical research on self-disorders consistently demonstrate: (i) that self-disorders hyper-aggregate in schizophrenia spectrum disorders but not in other mental disorders, including bipolar disorder (Parnas et al, 2003; Parnas et al, 2005b; Raballo et al, 2011; Haug et al, 2012; Raballo and Parnas, 2012; Nordgaard and Parnas, 2014), (ii) that self-disorders occur in genetically high-risk individuals (Raballo and Parnas, 2011), (iii) that self-disorders are temporarily stable over a 5-year period (Nordgaard et al, 2017); and finally (iv) prospective studies indicate that self-disorders predict transition to psychosis in an Ultra-High Risk for psychosis sample (Nelson et al, 2012) and that high baseline scores of self-disorders predict later transition to a schizophrenia spectrum diagnosis (Parnas et al, 2011, 2016)—for a review see Parnas and Henriksen (2014). Recently, self-disorders have been empirically explored as an intermediate phenotype of schizophrenia.…”

High levels of anomalous self‐experience are associated with longer duration of untreated psychosis

“…However, even though they may fluctuate to some extent, researchers and clinicians today see ASEs as mainly trait-like disturbances that are present before the occurrence of frank psychotic symptoms and that do not increase during persistent psychosis. 23,42,43 Thus, it is likely that ASEs are causally related to rather than a consequence of long DUP. We do not have reliability calculations for the DUP measures in the current study.…”

Clinical Manifestations of Self-disorders in Schizophrenia Spectrum Conditions

“… Self-disorders hyper-aggregate in schizophrenia spectrum disorders but not in other mental disorders [39][40][41][42][43]  There is no statistical difference in the level of selfdisorders among patients with schizophrenia and patients with the schizotypal disorder [41,43]  Self-disorders differentiate between first-admitted cases with bipolar psychosis and schizophrenia [42] and self-disorders occur more frequently in residual schizophrenia than in remitted bipolar psychosis [44]  Self-disorders occur in genetically high-risk individuals [45]  Self-disorders are detectable in community samples of adolescent diagnosed as suffering from "at-risk mental state" [46] and in clinical samples of young adults at Clinical High Risk for psychosis [47]  Prospective studies indicate that self-disorders predict transition to psychosis in an Ultra-High Risk for psychosis sample [48] and that high baseline scores of self-disorders predict later transition to a schizophrenia spectrum diagnosis [49,50]  Positive correlations have been found between self-disorders and positive symptoms, negative symptoms, formal thought disorders, and perceptual disturbances, respectively [43]  Correlations have been found between selfdisorders and social dysfunction [51] and suicidality [52,53], respectively  No correlations have been found between selfdisorders and IQ or neurocognitive measures [43,54,55], except for impaired verbal memory [54]  Self-disorders have been found to be temporarily stable over a 5-year period [56] …”